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Rosi Junior J, Gomes Dos Santos A, Solla DJF, Rabelo NN, da Silva SA, Iglesio RF, Caldas JGMP, Teixeira MJ, Figueiredo EG. Cavernous carotid aneurysms do not influence the occurrence of upstream ipsilateral aneurysm. Br J Neurosurg 2024; 38:205-207. [PMID: 33170054 DOI: 10.1080/02688697.2020.1820950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 08/29/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Cavernous carotid aneurysms (CCA) comprehend around 5% of all intracranial aneurysms. The main risk factors for an intracranial aneurysm seem not to influence the incidence of CCAs. The aim of this study was to investigate the association of CCAs and the presence of upstream aneurysms. METHODS 1403 patients, admitted in Hospital das Clinicas de São Paulo, Brazil, from September 2009 to August 2018, enrolled this study. Diagnosis was performed with Digital Subtraction Angiography (DSA). Upstream aneurysm was defined as an intracranial aneurysm on anterior cerebral circulation, ipsilateral to the CCA (if present) or crossing the midline (e.g. anterior communicating artery). RESULTS 177 individuals were diagnosed with CCA (12.6% of the population), totalizing 225 aneurysms (10% of the total number of aneurysms, 2253). No association was found between CCA and UA (p= .090, OR: 1.323, 95% CI: 0.957-1.828). Studying only patients with CCA, multivariable analysis showed smoking as the only factor associated with UA (p= .010, OR: 0.436, 95% CI: 0.232-0.821). CONCLUSIONS Cavernous carotid aneurysms were present in 12% of our population, mostly in female. They seem to be independent of the modifiable risk factors already associated with intracranial aneurysms. A higher frequency of mirror aneurysms was seen in this location. CCA did not influence the presence of ipsilateral and anterior circulation aneurysms.
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Affiliation(s)
- Jefferson Rosi Junior
- Division of Neurological Surgery, Hospital das Clinicas, University of São Paulo Medical School, Sao Paulo, Brazil
| | | | - Davi Jorge Fontoura Solla
- Division of Neurological Surgery, Hospital das Clinicas, University of São Paulo Medical School, Sao Paulo, Brazil
| | | | - Saul Almeida da Silva
- Division of Neurological Surgery, Hospital das Clinicas, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Ricardo Ferrareto Iglesio
- Division of Neurological Surgery, Hospital das Clinicas, University of São Paulo Medical School, Sao Paulo, Brazil
| | | | - Manoel Jacobsen Teixeira
- Division of Neurological Surgery, Hospital das Clinicas, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Eberval Gadelha Figueiredo
- Division of Neurological Surgery, Hospital das Clinicas, University of São Paulo Medical School, Sao Paulo, Brazil
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Salih M, Mallick A, Rai HH, Nwajei F, Cappuzzo JM, Snyder K, Ogilvy CS. Percutaneous transluminal angioplasty or stenting of petrous and cavernous internal carotid artery stenosis - a systematic review. J Neuroradiol 2024; 51:82-88. [PMID: 37364744 DOI: 10.1016/j.neurad.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 06/28/2023]
Abstract
Percutaneous transluminal angioplasty (PTA) and stenting have been used for the treatment of internal carotid artery (ICA) stenosis over the past two decades. A systematic review was performed to understand the efficacy of PTA and/or stenting for petrous and cavernous ICA stenosis. In total, 151 patients (mean age 64.9) met criteria for analysis, 117 (77.5%%) were male and 34 (22.5%) were female. Of the 151 patients, 35 of them (23.2%) had PTA, and 116 (76.8%) had endovascular stenting. Twenty-two patients had periprocedural complications. There was no significant difference in the complication rates between the PTA (14.3%) and stent (14.7%) groups. Distal embolism was the most common periprocedural complication. Average clinical follow up for 146 patients was 27.3 months. Eleven patients (7.5%) out of 146 had retreatment. The treatment of petrous and cavernous ICA with PTA and stenting has relatively significant procedure related complication rates and adequate long-term patency.
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Affiliation(s)
- Mira Salih
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street Boston, Boston, MA 02215, United States
| | - Akashleena Mallick
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street Boston, Boston, MA 02215, United States
| | | | - Felix Nwajei
- Boston Medical Center, Boston, MA, United States
| | | | - Kenneth Snyder
- University at Buffalo Neurosurgery, Buffalo, NY, United States
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street Boston, Boston, MA 02215, United States.
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Jabal MS, Mohammed MA, Kobeissi H, Lanzino G, Brinjikji W, Flemming KD. Quantitative image signature and machine learning-based prediction of outcomes in cerebral cavernous malformations. J Stroke Cerebrovasc Dis 2024; 33:107462. [PMID: 37931483 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE There is increasing interest in novel prognostic tools and predictive biomarkers to help identify, with more certainty, cerebral cavernous malformations (CCM) susceptible of bleeding if left untreated. We developed explainable quantitative-based machine learning models from magnetic resonance imaging (MRI) in a large CCM cohort to demonstrate the value of artificial intelligence and radiomics in complementing natural history studies for hemorrhage and functional outcome prediction. MATERIALS AND METHODS One-hundred-eighty-one patients from a prospectively registered cohort of 366 adults with CCM were included. Fluid attenuated inversion recovery (FLAIR) T2-weighted brain images were preprocessed, and CCM and surrounding edema were segmented before radiomic feature computation. Minority class oversampling, dimensionality reduction and feature selection methods were applied. With prospective hemorrhage as primary outcome, machine learning models were built, cross-validated, and compared using clinico-radiologic, radiomic, and combined features. SHapley Additive exPlanations (SHAP) was used for interpretation to determine the radiomic features with most contribution to hemorrhage prediction. RESULTS The highest performances in hemorrhage predictions on the test set were combining radiomic and clinico-radiological features with an area under the curve (AUC) of 83% using linear regression and selected features, and an F1 score of 61% and 85% sensitivity using K-nearest neighbors with principal component analysis (PCA). Multilayer perceptron had the best performance predicting modified Rankin Scale ≥ 2 with an AUC of 74% using PCA derived features. For interpretation of the selected radiomic signature XGBoost model, Shapley additive explanations highlighted 6 radiomic features contributing the most to hemorrhage prediction. CONCLUSION Quantitative image-based modeling using machine learning has the potential to highlight novel imaging biomarkers that predict hemorrhagic and functional outcomes, ensuring more precise and personalized care for CCM patients.
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Affiliation(s)
| | - Marwa A Mohammed
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Hassan Kobeissi
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Giuseppe Lanzino
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, United States
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Kelly D Flemming
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
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Akbari M, Jalali MM, Azad F. Cavernous Hemangioma of the Sternocleidomastoid Muscle: A Case Report. Iran J Otorhinolaryngol 2023; 35:217-221. [PMID: 37497161 PMCID: PMC10368166 DOI: 10.22038/ijorl.2023.67437.3302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 05/07/2023] [Indexed: 07/28/2023]
Abstract
Introduction Cavernous hemangioma is a venous malformation and intramuscular hemangioma is a rare type of hemangioma. Most of these cases are reported in masseter and temporalis muscles, and the number of patients with hemangioma involving sternocleidomastoid (SCM) muscle is relatively less. The present study reported a case of intramuscular hemangioma and a literature review regarding hemangioma in the sternocleidomastoid muscle. Case Report The present case was a 24-year-old woman with intramuscular hemangioma of the sternocleidomastoid muscle, manifesting a mass in the right supraclavicular region involving the sternocleidomastoid muscle. The woman was treated with surgery and achieved complete treatment. After surgery, the patient was kept under regular follow-up for the last six months without any evidence of recurrence. Conclusion Intramuscular hemangioma of the sternocleidomastoid muscle is a rare entity that can present as a mass in the neck region. The treatment approach should be considered according to the diagnosis and site of vascular malformation.
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Affiliation(s)
- Maryam Akbari
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Guilan University of Medical Sciences, Amiralmomenin Hospital, Rasht, Iran.
| | - Mir Mohammad Jalali
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Guilan University of Medical Sciences, Amiralmomenin Hospital, Rasht, Iran.
| | - Fatemeh Azad
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Guilan University of Medical Sciences, Amiralmomenin Hospital, Rasht, Iran.
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Ye Z, Li C, Liu Y, You M. Intraosseous venous malformation of the zygoma: Case report and pooled analysis. J Craniomaxillofac Surg 2023; 51:490-496. [PMID: 37574385 DOI: 10.1016/j.jcms.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/29/2023] [Accepted: 07/30/2023] [Indexed: 08/15/2023] Open
Abstract
The objective of this study is to provide a comprehensive summary of the clinical and radiological features of zygomatic intraosseous venous malformations (IVM), as well as its treatment strategies. The aim is to establish preoperative diagnostic bases that will aid in the identification of zygomatic IVM and facilitate the implementation of effective treatment. Four cases of pathologically diagnosed zygomatic IVM with typical clinical and radiological features were reported. They exhibited comparable clinical and radiological features, and the En bloc excision and reconstruction yielded satisfactory outcome. Pooled data analysis was performed with additional 74 cases collected from 63 previous studies. The results revealed a higher incidence of zygomatic IVMs in middle-aged females, with swelling, pain and ocular dysfunction being the typical clinical manifestations. The characteristic radiological features of these lesions were well-defined, round bony structures with specific internal trabecular patterns. A diagnostic flow-chart assisting the differential diagnosis of IVM was established. En bloc excision was deemed the most advantageous treatment option, as it presented minimal risk of haemorrhaging and no instances of recurrence. The decision to pursue reconstruction was contingent upon the extent of the defect. Alloplastic material has emerged as the most frequently employed reconstruction material in recent reports. The summarized characteristics of zygomatic IVM and the proposed diagnostic and treatment strategies, derived from the pooled analysis of reported cases, may help to improve diagnosis and management in further clinical practice.
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Affiliation(s)
- Zelin Ye
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Oral Medical Imaging, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Chenyang Li
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Oral Medical Imaging, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - YuanYuan Liu
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Oral Medical Imaging, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Meng You
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Oral Medical Imaging, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.
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Abstract
Cavernous sinus haemangiomas are neoplastic lesions notoriously difficult to diagnose and excise. We present a case of a lesion that was clinically, biochemically, and radiologically consistent to a giant pituitary macroadenoma and discuss the unexpected near intra-operative exsanguination which enabled a pathognomonic diagnosis of a much rarer lesion to be made. This highlights the sinister nature of such a lesion, and its potential impact on patient care if partially excised, and that despite our advances in neurosurgical diagnostics the unexpected is to be expected.
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Affiliation(s)
- Simon Lammy
- Department of Neurosurgery, Institute of Neurological Sciences, Glasgow, UK
| | - Jennifer Brown
- Department of Neurosurgery, Institute of Neurological Sciences, Glasgow, UK
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Mokadem S, Chakroun M, Hermi A, Saadi A, Zaghbib S, Ben Slama MR. Air gun accident: A case report of a penile injury. Urol Case Rep 2023; 47:102371. [PMID: 36910506 PMCID: PMC9995279 DOI: 10.1016/j.eucr.2023.102371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 03/05/2023] Open
Abstract
Air rifle, although considered as a toy, can cause injuries ranging from trivial to very grievous. The severity of injuries depends on the type of air rifle, the distance of firing, and the anatomic site at which the bullet hits. We present a case involving a young boy, who was accidently hit by an air rifle while playing. The Bullet penetrated the penis through the glans to be lodged in between the distal extremities of the corpus cavernosum behind the urethra. The surgical treatment was performed and the results were good.
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Affiliation(s)
- Seif Mokadem
- University of Tunis El Manar, Faculty of Medicine, Charles Nicolle Hospital of Tunis, Urology Department, Tunisia
| | - Marouene Chakroun
- University of Tunis El Manar, Faculty of Medicine, Charles Nicolle Hospital of Tunis, Urology Department, Tunisia
| | - Amine Hermi
- University of Tunis El Manar, Faculty of Medicine, Charles Nicolle Hospital of Tunis, Urology Department, Tunisia
| | - Ahmed Saadi
- University of Tunis El Manar, Faculty of Medicine, Charles Nicolle Hospital of Tunis, Urology Department, Tunisia
| | - Selim Zaghbib
- University of Tunis El Manar, Faculty of Medicine, Charles Nicolle Hospital of Tunis, Urology Department, Tunisia
| | - Mohamed Riadh Ben Slama
- University of Tunis El Manar, Faculty of Medicine, Charles Nicolle Hospital of Tunis, Urology Department, Tunisia
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Gorjian M, Raymond S, Koch M, Patel A. Covered stent delivery in tortuous internal carotid artery for treatment of direct carotid cavernous fistula. Neurocirugia (Astur : Engl Ed) 2023; 34:97-100. [PMID: 36868627 DOI: 10.1016/j.neucie.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/29/2022] [Indexed: 03/05/2023]
Abstract
Direct carotid cavernous fistulas (dCCF) are high-flow shunts between the internal carotid artery (ICA) and cavernous sinus and are commonly caused by traumatic injuries. Endovascular intervention using detachable coils, with or without stenting, is often the treatment of choice; however, migration or compaction of the coils can occur due to high-flow nature of dCCFs. Alternatively, deployment of a covered stent in ICA can be considered for treatment of dCCFs. We report a case of dCCF with tortuous intracranial ICA successfully treated by placement of a covered stent graft and we will illustrate the technical aspects of the procedure. In the presence of a tortuous ICA navigation and deployment of covered stents is technically complicated and requires modified maneuvers.
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Affiliation(s)
- Mehrnoush Gorjian
- Department of Neurology, University of New Mexico, 900 Camino de Salud, Albuquerque, NM 87131, United States.
| | - Scott Raymond
- Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, United States
| | - Matthew Koch
- Department of Neurosurgery, University of Florida, 1505 SW archer Rd, Gainesville, FL 32608, United States
| | - Aman Patel
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
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9
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Dash M, Pathi J, Singh DK, Sangamesh NC. Intraosseous Hemangioma with unusual presentation. J Family Med Prim Care 2022; 11:5662-5666. [PMID: 36505628 PMCID: PMC9730978 DOI: 10.4103/jfmpc.jfmpc_1673_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/27/2021] [Accepted: 12/20/2021] [Indexed: 12/15/2022] Open
Abstract
Intrabony vascular lesions are extremely rare conditions. The lesions include 0.5% to 1% of all intraosseous tumors. Females are more predilected than males with a female: male ratio of 2:1, usually affecting the second decade of life. Most common sites of occurrence of these lesions are in the vertebral column and skull, jaws are the rare location with the mandible being the quite rare location. The origin of hemangiomas is still doubtful. Many of the authors believe it as hamartoma but as per World Health Organization, it as a true benign neoplasm of vascular origin. The clinical presentation of hemangiomas is variable with atypical radiographic presentations. Due to the varied presentations of this lesion, the diagnosis becomes very difficult. But diagnosing central hemangiomas early is essential for preventing uncontrollable hemorrhage and even death during any surgical intervention. We present a case of intraosseous cavernous hemangioma which presented as periapical radiolucency with specks of calcification, quiet a rare presentation. The case was managed by embolization followed by surgical resection of the body of the mandible.
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Affiliation(s)
- Monalisa Dash
- Paediatric Pathogy, Seth GS and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Jugajyoti Pathi
- Department of Oral and Maxillofacial Surgery, Kalinga Institute of Dental Sciences, KIIT DU, Bhubaneswar, Odisha, India
| | - Dhirendra K. Singh
- Department of Periodontology and Oral Implantology, Kalinga Institute of Dental Sciences, KIIT DU, Bhubaneswar, Odisha, India
| | - NC Sangamesh
- Department of Oral Medicine and Radiology, Kalinga Institute of Dental Sciences, KIIT DU, Bhubaneswar, Odisha, India,Address for correspondence: Dr. Sangamesh NC, Professor, Department of Oral Medicine and Radiology, Kalinga Institute of Dental Sciences, KIIT DU, Bhubaneswar, India. E-mail:
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Helmi HA, Alkatan HM, Al-Essa RS, Aljudi TW, Maktabi AMY, Eberhart CG. Choroidal hemangioma in Sturge Weber syndrome: Case series with confirmed tissue diagnosis. Int J Surg Case Rep 2021; 89:106626. [PMID: 34847393 PMCID: PMC8639421 DOI: 10.1016/j.ijscr.2021.106626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/20/2021] [Accepted: 11/21/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Sturge-weber syndrome (SWS) is a rare condition that presents with a typical facial port-wine stain, neurological manifestations such as seizures, and ocular involvement by glaucoma and/or choroidal hemangioma. In this series we demonstrate the histopathological details of the primary ocular involvement as well as the late blinding secondary ocular changes. Presentation of cases Seven cases were included with the diagnosis of choroidal hemangioma in association with SWS (6 enucleations and one evisceration). Male to female ratio was 4:3. Age at enucleation/evisceration ranged from 25 to 68 years with a median of 42 years. Five cases had history of glaucoma (71.4%). Diffuse hemangioma was found in all (4 cavernous and 3 mixed cavernous/capillary type). Conjunctival and episcleral hemangiomas were found in 3/7. Iris neovascularization and retinal detachment were confirmed in 5/7 cases each (71%). Discussion Our demographic and histopathological findings parallel what was previously concluded in the literature about the lack of gender predilection in SWS, and the most common ocular presentations of glaucoma and choroidal hemangioma, which is mostly diffuse in nature. The hemangioma type was found to be mostly cavernous followed by mixed capillary and cavernous. We demonstrated late associated ocular changes such as cataract, iris neovascularization, exudative retinal detachment, retinal pigment epithelium hyperplasia/metaplasia, and optic nerve atrophy, all of which aid in the poor visual outcome in these patients. Conclusion Sturge-weber syndrome is a rare but visually disabling disease due to the associated ocular manifestations of glaucoma and choroidal hemangioma. Multidisciplinary approach because of the diverse presentation of this condition by pediatrician, neurologist, and ophthalmologist is essential with an attempt to preserve vision. Sturge-weber syndrome (SWS) is a rare, condition manifesting with port-wine stains, seizures, glaucoma, and hemangiomas. Diffuse choroidal hemangioma (DCH) is the typical ocular lesion in SWS. We report 7 cases with histologically confirmed SWS-associated DCHs and their relevant visually disabling complications. Early diagnosis and treatment are essential for improved visual outcome.
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Affiliation(s)
- Hala A Helmi
- Ophthalmology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hind M Alkatan
- Ophthalmology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Pathology and Laboratory Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
| | - Rakan S Al-Essa
- Ophthalmology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Talal W Aljudi
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Azza M Y Maktabi
- Pathology and Laboratory Medicine Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Charles G Eberhart
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA; Department of Ophthalmology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA; Department of Oncology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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11
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Abstract
BACKGROUND Gastrointestinal hemangiomas are very rare and are even rarer in the mesorectum. It is not clear whether mesorectal hemangiomas originate in the bowel wall or in the mesorectum. For clinicians, to correctly identify the imaging features of mesorectal hemangiomas is important. CASE PRESENTATION We herein describe a case of a 31-year-old male that presented with hematochezia and sensation of rectal tenesmus. Both the rectal MRI and contrast-enhanced CT scan of the whole abdomen indicated rectal wall thickening, marked dilatation, and tortuous vessels around the rectum. In addition, a contrast-enhanced portal venous phase CT scan showed the dilation of portal vein, splenic vein and inferior mesenteric vein. The dilated inferior mesenteric vein extending down to the mesorectum, and became marked dilatation and tortuous vessels around the rectum. The patient underwent laparoscopic surgical resection of the mesorectal lesion and the involved portions of the rectum. The surgical samples underwent pathological analysis, and a diagnosis of cavernous hemangioma was confirmed. Seven days after surgery, the patient was discharged without postoperative complications. CONCLUSIONS This case highlights the imaging features of mesorectal hemangiomas. In addition, in this current case, the mesorectal hemangioma more likely originated in the mesorectum.
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Affiliation(s)
- Yan Zhang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, China
| | - Bing Wu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, China.
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Martínez-Pérez R, Tsimpas A, Marin-Contreras F, Maturana R, Hernandez-Alvarez V, Labib MA, Poblete T, Rubino P, Mura J. The Minimally Invasive Posterolateral Transcavernous-Transtentorial Approach. Technical Nuances, Proof of Feasibility, and Surgical Outcomes Throughout a Case Series of Sphenopetroclival Meningiomas. World Neurosurg 2021; 155:e564-e575. [PMID: 34478889 DOI: 10.1016/j.wneu.2021.08.108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Sphenopetroclival (SPC) meningiomas are considered among the most complex skull-base neoplasms to approach surgically. We aim to determine whether some SPC meningiomas can be safely and effectively treated using a modified minimally invasive pterional posterolateral transcavernous-transtentorial approach (MIPLATTA). METHODS Fourteen patients harboring SPC meningiomas were surgically treated through a MIPLATTA. MIPLATTA includes a minipterional craniotomy, anterior extradural clinoidectomy, peeling of the temporal fossa, decompression of cranial nerves (CNs) in the cavernous sinus, and sectioning of the tentorium to reach the upper part of the posterior fossa. RESULTS Gross total resection was achieved in 11 of 14 patients (78%), whereas near-total resection was accomplished in the other 3 patients (22%), each of whom underwent a further complementary retrosigmoid approach for gross total tumor resection. There were no deaths, and 13 of 14 patients were independent at 6 months follow-up (modified Rankin Scale score ≤2). One patient had pontine infarction after the procedure and experienced moderate disability at follow-up (modified Rankin Scale score 3). All patients had some degree of CN impairment. Of 38 cranial neuropathies, 15 (39%) improved, 20 (53%) remained stable, and 3 (8%) worsened postoperatively. Four new CN deficits were observed postoperatively in 3 patients (fourth CN, 2 patients; third CN, 1; fifth CN, 1). CONCLUSIONS MIPLATTA is a useful and safe treatment alternative that allows resection of large SPC tumors with dominant invasion of cavernous sinus and middle fossa, preserves hearing and facial motor function, and provides good chances of recovery of visual and oculomotor deficits.
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Affiliation(s)
- Rafael Martínez-Pérez
- Department of Neurosurgery, Neuroscience Institute, Geisinger Health System and Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA; Department of Cerebrovascular and Skull Base Pathologies, Instituto Nacional de Neurocirugía Dr Asenjo, Universidad de Chile, Santiago, Chile.
| | - Asterios Tsimpas
- Department of Neurosurgery, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Francisco Marin-Contreras
- Department of Cerebrovascular and Skull Base Pathologies, Instituto Nacional de Neurocirugía Dr Asenjo, Universidad de Chile, Santiago, Chile
| | - Rolando Maturana
- Department of Cerebrovascular and Skull Base Pathologies, Instituto Nacional de Neurocirugía Dr Asenjo, Universidad de Chile, Santiago, Chile
| | | | - Mohamed A Labib
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Tomas Poblete
- Department of Cerebrovascular and Skull Base Pathologies, Instituto Nacional de Neurocirugía Dr Asenjo, Universidad de Chile, Santiago, Chile; Department of Anatomy and Legal Medicine, University of Chile School of Medicine, Santiago, Chile
| | - Pablo Rubino
- Department of Neurosurgery, Hospital el Cruce, Buenos Aires, Argentina
| | - Jorge Mura
- Department of Cerebrovascular and Skull Base Pathologies, Instituto Nacional de Neurocirugía Dr Asenjo, Universidad de Chile, Santiago, Chile; Department of Neurological Sciences, Universidad de Chile, Santiago, Chile; Department of Neurosurgery, Clinica Las Condes, Santiago, Chile
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13
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Abstract
Hemangiomas are benign vascular tumors that most often affect the skin, mucous membranes, subcutaneous tissues, bone and on rare occasions muscles. In the head and neck region, the masseter and trapezius muscles are most often affected; the temporalis muscle involvement is extremely rare. It is a childhood pathology that rarely occurs in adults. We report a case of a cavernous hemangioma in a 37-year-old female. Through this case and in the light of literature we focus on the clinicopathological aspects of this tumor and the rarity of this location.
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Affiliation(s)
- Zahra Sayad
- Department of Oral and Maxillofacial Surgery, Ibn Sina University Hospital Center, Rabat, Morocco
| | - Bouchra Dani
- Department of Oral and Maxillofacial Surgery, Ibn Sina University Hospital Center, Rabat, Morocco
| | - Salma Benazzou
- Department of Oral and Maxillofacial Surgery, Ibn Sina University Hospital Center, Rabat, Morocco
| | - Malik Boulaadas
- Department of Oral and Maxillofacial Surgery, Ibn Sina University Hospital Center, Rabat, Morocco
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Almaghrabi N, Fatani Y, Saab A. Cavernous internal carotid artery aneurysm presenting with ipsilateral oculomotor nerve palsy: A case report. Radiol Case Rep 2021; 16:1339-1342. [PMID: 33897925 PMCID: PMC8056302 DOI: 10.1016/j.radcr.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 10/24/2022] Open
Abstract
The oculomotor nerve palsy is a rare neurological deficit, it is associated with numerous underlying pathologies. Including stroke, neoplasms, trauma, post-surgical inflammation, and microvascular damage from chronic disease. It can cause a set of neurological deficits, including diplopia from oculomotor nerve involvement, decreased visual acuity from optic neuropathy, facial hypoesthesia from involvement of the trigeminal nerve, and less frequently facial pain. We present a case of 52 years old female patient who presented with a history of lateral divination of the left eye associated with ipsilateral drooping of upper eyelid, visual disturbance, and pupil dysfunction. MRI and MRA were performed and in conventional sequences plus 3D FIESTA sequence and it shows a signal void structure, compressing the left oculomotor nerve after passing through left chiasmatic cistern and upon entrance to cavernous sinus. Reformatted images demonstrate that this structure arising from distal left internal carotid artery at lateral part of cavernous sinus represents a saccular aneurysm in the cavernous part of the internal carotid. Aneurysms can cause direct compression of the third cranial nerve either by the enlargement of an unruptured aneurysm or by rupture of the aneurysmal sac resulting in third cranial nerve palsy.
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Affiliation(s)
- Nizar Almaghrabi
- Radiology resident, King Abdulaziz Hospital, Makkah, Saudi Arabia
| | - Yousef Fatani
- Radiology resident, King Abdulaziz Hospital, Makkah, Saudi Arabia
| | - Abeer Saab
- Neuroradiology Consultant, King Abdulaziz Hospital, Makkah, Saudi Arabia
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Abstract
BACKGROUND Adrenal hemangioma is a rare benign adrenal tumor that is usually misdiagnosed preoperatively. We here present a case of adrenal cavernous hemangioma that was successfully treated with retroperitoneal laparoscopic adrenalectomy. CASE PRESENTATION A 67-year-old man with dull right back pain attended our clinic for examination of a mass on the right adrenal gland for 1 week. Pheochromocytoma was considered according to the preoperative computed tomography angiography + computed tomography urography findings and was subsequently corrected to adrenal gland hemangioma according to postoperative pathological findings. The patient showed no recurrence of adrenal hemangioma during the 1-year follow-up period after surgery. CONCLUSION Adrenal gland hemangioma is rare with a high rate of misdiagnosis, and it should be considered in imaging findings of adrenal tumors with typical hemangioma. Surgery is an effective treatment method.
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Affiliation(s)
- Ting Huang
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, China.
| | - Qing Yang
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, China
| | - Yang Hu
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, China
| | - Hai-Xiao Wu
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, China
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Martinez-Perez R, Florez-Perdomo W, Freeman L, Ung TH, Youssef AS. Long-term disease control and treatment outcomes of stereotactic radiosurgery in cavernous sinus meningiomas. J Neurooncol 2021; 152:439-49. [PMID: 33772678 DOI: 10.1007/s11060-021-03732-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Most of the current knowledge on the clinical effects of stereotactic radiosurgery (SRS) on the treatment of cavernous sinus meningiomas (CSM) is based on series with limited follow-up. However, determining the role of radiation in a tumor with slow disease progression such as CSM necessitates long term follow up. OBJECTIVE To review and pool metadata in the literature to determine the long-term outcomes of SRS with respect to clinical and radiographic tumor control of CSM. METHODS A systematic search was conducted following MOOSE guidelines. Results were screened against predefined criteria, which excluded studies with a median follow-up less than 5 years. The incidences of each outcome were calculated using random-effects metanalysis of proportions. RESULTS Seven studies met the inclusion criteria, comprising 645 patients. The median follow-up was 74 months (range 62-87). Progression-free-survival at 5, 10, and 15 years was 93.4% (95% CI 89.1-96.7%), 84.9% (95% CI 77-91.4%), and 81.3% (95% CI 74-87.7%), respectively. Clinical response to SRS at last follow-up defined as improvement of cranial nerve deficits was found in in 36.4% (95% CI 26.3-47.1%) of patients, while worsening or onset of new cranial nerve deficits was found in 11.5% (95% CI 7.9-15.7%). Radiological regression was found in 57.8% (95% CI 43-71.8%), while tumor progression was found in 8.5% (95% CI 5.2-12.6%). CONCLUSION SRS achieves excellent disease control and radiographic response in CSM. Although the risk of long-term cranial neuropathies is minimal, it is relatively higher to what has been previously reported in early series with limited follow-up.
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Mabray M, Hart B. Clinical Imaging of Cerebral Cavernous Malformations: Computed Tomography and Magnetic Resonance Imaging. Methods Mol Biol 2020; 2152:85-96. [PMID: 32524546 DOI: 10.1007/978-1-0716-0640-7_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This is a review of imaging techniques used to evaluate cerebral cavernous malformations (CCMs) and imaging findings associated with CCMs. This chapter includes discussion of computed tomography and magnetic resonance imaging sequences, appearance of CCMs and associated hemorrhage and key features to evaluate on imaging studies.
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Alshomar KM, Alkatan HM, Alrikabi AC, Al-Faky YH. A case of dyschromatosis symmetrica hereditaria with an associated eyelid hemangioma. Int J Surg Case Rep 2021; 79:73-5. [PMID: 33434773 DOI: 10.1016/j.ijscr.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/03/2021] [Accepted: 01/03/2021] [Indexed: 12/01/2022] Open
Abstract
Dyschromatosis symmetrica hereditaria (DSH) is a rare pigmentary skin disorder. Our case is a 25-year-old female with DSH presenting with eyelid hemangioma. She had history of cutaneous lupus erythematosus (CLE) and nodular goiter. The association of the hemangioma, CLE, and hyperthyroidism with DSH is interesting.
Introduction and importance Dyschromatosis symmetrica hereditaria (DSH) are rare autosomal dominant pigmentary genodermatosis characterized by reticular hyper- and hypopigmented skin macules on the dorsal aspect of the extremities and freckle-like spots on the face, sparing the palms and soles. Cutaneous hemangiomas were not reported in the literature with DSH. We describe for the first time to the best of our knowledge a case of DSH with histopathologically confirmed eyelid hemangioma. Case presentation A 25-year-old female was diagnosed with DSH in her childhood by a dermatologist then later developed cutaneous lupus erythematosus (CLE). Four years later she presented to our clinic with right lower eyelid painless mass. The histopathological examination showed inflamed epidermis overlying a mixed capillary and cavernous hemangioma. The patient had complete healing of the skin post-operatively with excellent cosmetic result. Discussion DSH is usually isolated, however, acral hypertrophy, psoriasis, dental anomalies, aortic valve sclerosis, dystonia and intracranial hemangiomas have been reported in association with the disease. The types of the hemangiomas reported were not specified with lack of tissue diagnosis. Our case is unique because of the late occurrence of this eyelid skin hemangioma, the concomitant CLE, the history of hyperthyroidism, and the positive family history of consanguinity. Conclusion The pathogenesis of DSH is not well understood, however the previously reported intracranial hemangiomas and the currently reported skin vascular lesion would raise the role of inheritance and variable expression of such an association especially with concomitant CLE. This may warrant further studies on the etiology of DSH.
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Jia L, Wang J, Zhang L, Zhang Y, You W, Yang X, Lv M. Evaluating the Tubridge™ flow diverter for large cavernous carotid artery aneurysms. Chin Neurosurg J 2020; 6:36. [PMID: 33292725 PMCID: PMC7708900 DOI: 10.1186/s41016-020-00215-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/14/2020] [Indexed: 11/21/2022] Open
Abstract
Background The Tubridge™ flow diverter (TFD) was recently developed in China; however, its safety and efficacy in treating large cavernous carotid artery aneurysms (LCCAs) are unclear. Our objective was to evaluate the safety and efficacy of the TFD in patients receiving TFDs to treat LCCAs (10–25 mm). Methods Between June 2013 and May 2014, seven patients with LCCAs were enrolled in our study, and all seven patients underwent TFD implantation combined with coils. Results Angiographic follow-up images were available for all seven patients at a median of 57.5 ± 16.7 (range, 6–69) months. Seven patients obtained favorable angiographic results defined as O’Kelly–Marotta Scale C and D. Clinical follow-up data were available for all seven patients at a median of 73.32 ± 3.6 (range, 66–78) months. No patients developed new neurological deficits. Six patients achieved a modified Rankin scale score of 0, and diplopia improved in the remaining patient. Conclusions The results were excellent for the aneurysms treated with TFDs in our patients with LCCAs. TFDs are feasible for the treatment of LCCAs, but a multicenter, controlled clinical trial is needed to evaluate the long-term safety and efficacy of the TFD to treat LCCAs.
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Affiliation(s)
- Luqiong Jia
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100070, China
| | - Jiejun Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100070, China
| | - Longhui Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yunfeng Zhang
- Department of Imaging and Nuclear Medicine, Baoding No. 1 Central Hospital, Baoding, Hebei, China
| | - Wei You
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100070, China.
| | - Ming Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100070, China.
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20
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Rafie A, Jolly K, Darr A, Thompson S. Adult cavernous haemangioma of the vocal cords with a unique presentation of acute respiratory distress: a case report. Ann R Coll Surg Engl 2020; 102:e152-e154. [PMID: 32306741 PMCID: PMC7450425 DOI: 10.1308/rcsann.2020.0066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2020] [Indexed: 11/22/2022] Open
Abstract
Laryngeal haemangiomas can commonly be seen in children, and first-line treatment is usually propranolol. However, in adults, cavernous haemangioma of the vocal cord(s) is an extremely rare condition - with this being the only published adult case presenting with acute respiratory distress - the mainstay of treatment is surgical excision under microlaryngoscopy. Presentation in adults can be unpredictable, but primarily consists of hoarseness which can be associated with, dyspnoea, dysphagia, and haemoptysis - and in one documented case stenosis of the aero-digestive tract led to death. Due to these airway difficulties, surgery can often prove challenging. In this study, we explore the unusual case of a previously well 71-year-old gentleman presenting to the Emergency Department, with worsening shortness of breath as his primary complaint. Uniquely, in this case, an awake fibre-optic intubation was undertaken to manage the difficult airway and a microlaryngoscopy was performed. A 20x10x15mm lesion was excised, which had characteristics in keeping with a cavernous haemangioma on microscopic examination.
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Affiliation(s)
- A Rafie
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - K Jolly
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - A Darr
- New Cross Hospital, Wolverhampton, UK
| | - S Thompson
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
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21
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Shashikanth M, Nicola S, Yi C, Julian S. Right atrial cavernous hemangioma. Ann Card Anaesth 2020; 23:335-337. [PMID: 32687093 PMCID: PMC7559951 DOI: 10.4103/aca.aca_58_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Benign cardiac hemangiomas are rare tumors that may present in or out side of the heart, epicardium being the most common site. Echocardiography is the method of choice in diagnosing cardiac masses and though 3D TEE may seem to add exact information about the location, the time constraint in doing a comprehensive examination along with 3D rendering inside operation room may become an hindrance.
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Affiliation(s)
- Manikappa Shashikanth
- Department of Anaesthesia and Perioperative Medicine, Monash Health, Clayton, Australia
| | - Sandler Nicola
- Department of Cardiothoracic Surgery, Monash Health, Clayton, Australia
| | - Chen Yi
- Department of Cardiothoracic Surgery, Monash Health, Clayton, Australia
| | - Smith Julian
- Department of Cardiothoracic Surgery, Monash Health, Clayton; Department of Surgery, (School of Clinical Sciences at Monash Health), Monash University, Melbourne, Victoria, Australia
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Flemming KD, Kumar S, Brown RD, Singh RJ, Whitehead K, McCreath L, Lanzino G. Cavernous Malformation Hemorrhagic Presentation at Diagnosis Associated with Low 25-Hydroxy-Vitamin D Level. Cerebrovasc Dis 2020; 49:216-222. [PMID: 32348981 DOI: 10.1159/000507789] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/08/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cavernous malformations (CM) are angiographically occult vascular malformations that may be incidental or present with intracerebral or spinal hemorrhage, seizures, or nonhemorrhagic focal neurologic deficit (FND). Recently in vitro data have suggested vitamin D may play a role in stabilizing CCM2 endothelial cells. Little is known about the effect of vitamin D in human CM disease. METHODS Beginning in 2015, consecutive patients at our institution with radiologically confirmed CM were recruited to participate in a prospective clinical registry as well as 25-hydroxy-vitamin D study. A structured interview, survey, and examination were performed at baseline. Medical records and magnetic resonance imaging studies were reviewed and data collected included comorbid conditions, medication use, and location of CM. Standard definition of clinical hemorrhage, FND, and seizures was used. Univariate and multivariate logistic regression models were used, and OR, 95% CIs, and likelihood-ratio p values were calculated to determine the influence of the 25-hydroxy-vitamin D level on clinical presentation with hemorrhage. RESULTS Of 213 patients enrolled in the clinical registry between January 2015 and October 2018, 70 participated in the vitamin D study (median age: 38.3 years; 51.4% female). Of the 70 participants, 30 (42.9%) presented with hemorrhage. 25-Hydroxy-vitamin D levels were performed within 1 year of symptoms in 64.1% of patients. Patients presenting with hemorrhage had a lower 25-hydroxy-vitamin D level compared to those presenting with seizure without hemorrhage, FND, or as an incidental finding (median 25.5 ng/mL; range 11-59 hemorrhage vs. median 31.0; range 14-60, no hemorrhage; p = 0.04). After adjusting for age, month of blood draw, and body mass index, 25-hydroxy-vitamin D remained a significant predictor of hemorrhagic presentation. Brainstem location also predicted hemorrhage at presentation. CONCLUSION Low 25-hydroxy-vitamin D level was more common in patients with CM presenting with hemorrhage. This study supports the potential role of modifiable factor in the initial clinical presentation of CM. Further study is needed to determine the role of vitamin D on prospective hemorrhage risk and whether supplementation may be beneficial.
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Affiliation(s)
- Kelly D Flemming
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA,
| | - Shivram Kumar
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert D Brown
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ravinder J Singh
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kevin Whitehead
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Lauren McCreath
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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Martinez-Perez R, Silveira-Bertazzo G, Carrau RL, Prevedello DM. The importance of landmarks in endoscopic endonasal reinterventions: the transpterygoid trans cavernous approach. Acta Neurochir (Wien) 2020; 162:875-880. [PMID: 31912353 DOI: 10.1007/s00701-019-04206-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Sellar and parasellar regions are anatomically complex region and in close relationship with important neurovascular structures. Hence, surgical treatment of recurrent aggressive pituitary adenomas invading the cavernous sinus represents an operative challenge, given the lack of landmarks that are missed because of the scar tissue and previous interventions. METHODS We describe in detail the surgical technique of the transpterygoid transcavernous approach (TPTCa) for the surgical re-operation of a recurrent pituitary adenoma invading the left cavernous sinus in the context of a Nelson syndrome after bilateral adrenalectomy. We highlight the main anatomical key elements involved in this approach as well as the technical aspects for avoiding surgical complications. CONCLUSION The TPTCa is a versatile approach that uses the endoscopic transsphenoidal route and thereby, avoids brain retraction. Anatomic landmarks offer a good sense of the area that is exposed in reoperations and reduce the risk of injury of important neurovascular structures located within the cavernous sinus and the parasellar region.
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Macki M, Anand SK, Jaratli H, Dabaja AA. Penile Lymphangioma: review of the literature with a case presentation. Basic Clin Androl 2019; 29:1. [PMID: 30705756 PMCID: PMC6348653 DOI: 10.1186/s12610-018-0081-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background Penile lymphangiomas are rare manifestations of lymphangiomas or lymphatic malformations which are more commonly found in the head or neck region of the body. Lymphangiomas are further categorized as lymphangioma circumscriptum, cavernous lymphangioma, cystic hygroma, or acquired lymphangiomas (also known as lymphangiectasia), based on their depth and etiology. Results A literature review revealed only 30 cases of penile lymphangioma between 1947 and March 30, 2018. Several causes were attributed to the acquired penile lymphangiomas, including trauma, phimosis, and infection. While penile lymphangiomas can be initially mistaken for an infection, a thorough history and physical examination is sufficient to clinically diagnose a lymphangioma of the penis. Historically, surgical excision has been the gold standard of treatment for this condition. When asymptomatic, patients may opt for conservative management with avoidance of mechanical trauma alone. Other physicians have revealed novel treatment plans to rid patients of their penile lymphangioma such as a staged laser procedure. Conclusion In this article, we elucidate the causes, symptoms, treatments, and outcomes associated with penile lymphangiomas found in the literature while also presenting the case of a 30-year-old African-American man diagnosed with acquired penile lymphangioma.
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Affiliation(s)
- Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202 USA
| | - Sharath Kumar Anand
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202 USA
| | - Hayan Jaratli
- Department of Pathology, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202 USA
| | - Ali A Dabaja
- 3Department of Vattikuti Urology Institute, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202 USA
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Sgreccia A, Caragliano A, Sanfilippo G, Campa S, Trignani R, Giannoni M, De Nicola M, Consoli A, Rodesch G, Polonara G. Rare and Symptomatic Cavernous Donut-Shaped Aneurysm Treated by Flow Diverter Deployment. World Neurosurg 2019; 121:227-31. [PMID: 30312811 DOI: 10.1016/j.wneu.2018.09.219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND We describe the case of a 62-year-old woman who was admitted to our center for acute diplopia secondary to a left III cranial nerve palsy, left eyelid swelling and ptosis, and mild ipsilateral retroorbital pain. No other motor or sensitive deficits were observed. CASE DESCRIPTION Computed tomography angiography and digital subtraction angiography were performed, showing a 25-mm left intracavernous aneurysm with a central intrasaccular thrombus, an intrasaccular "swirling" flow with a donut-shape appearance. A flow-diverter stent was deployed bridging the aneurysmal neck. CONCLUSIONS Twelve months after the procedure the aneurysm was completely occluded, and the patient had totally recovered the cavernous syndrome. A careful literature review has been performed, and the different endovascular approaches have been analyzed.
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Ehresman JS, Mampre D, Rogers D, Olivi A, Quinones-Hinojosa A, Chaichana KL. Volumetric tumor growth rates of meningiomas involving the intracranial venous sinuses. Acta Neurochir (Wien) 2018; 160:1531-1538. [PMID: 29869111 DOI: 10.1007/s00701-018-3571-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 05/22/2018] [Indexed: 12/23/2022]
Abstract
OBJECT There is currently no consensus as to whether meningiomas located inside the venous sinuses should be aggressively or conservatively treated. The goals of this study were to identify how sinus-invading meningiomas grow, report and compare growth rates of tumor components inside and outside the different venous sinuses, identify risk factors associated with increased tumor growth, and determine the effects of the extent of tumor resection on recurrence for meningiomas that invade the dural venous sinuses. METHODS Adult patients who underwent primary, non-biopsy resection of a WHO grade 1 meningioma invading the dural venous sinuses at a tertiary care institution between 2007 and 2015 were retrospectively reviewed. Rates of tumor growth were fit to several growth models to evaluate the most accurate model. Cohen's d analysis was used to identify associations with increased growth of tumor in the venous sinuses. Logistic regression was used to compare extent of resection with recurrence. RESULTS Of the 68 patients included in the study, 34 patients had postoperative residual tumors in the venous sinuses that were measured over time. The growth model that best fit the growth of intrasinus meningiomas was the Gompertzian growth model (r2 = 0.93). The annual growth rate of meningiomas inside the sinuses was 7.3%, compared to extrasinus tumors with 13.6% growth per year. The only factor significantly associated with increased tumor growth in sinuses was preoperative embolization (effect sizes (ES) [95% CI], 1.874 [7.633-46.735], p = 0.008). CONCLUSIONS This study shows that meningiomas involving the venous sinuses have a Gompertzian-type growth with early exponential growth followed by a slower growth rate that plateaus when they reach a certain size. Overall, the growth rate of the intrasinus portion is low (7.3%), which is half of the reported growth rates for other studies involving primarily extrasinus tumors.
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Affiliation(s)
- Jeffrey S Ehresman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Mampre
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Davis Rogers
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Kaisorn L Chaichana
- Department of Neurosurgery, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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Tripathi M, Batish A, Kumar N, Ahuja CK, Oinam AS, Kaur R, Narayanan R, Gurnaani J, Kaur A. Safety and efficacy of single-fraction gamma knife radiosurgery for benign confined cavernous sinus tumors: our experience and literature review. Neurosurg Rev 2020; 43:27-40. [PMID: 29633079 DOI: 10.1007/s10143-018-0975-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 12/23/2017] [Accepted: 03/28/2018] [Indexed: 01/29/2023]
Abstract
Gamma knife radiosurgery (GKRS) has emerged as a suitable primary treatment option for confined cavernous sinus tumors (CSTs) and residual/recurrent benign tumors extending from the surrounding neighborhood. The aim of this review was to further investigate the safety and efficacy of single-fraction GKRS for primary confined CSTs (hemangioma, meningioma, and schwannoma). This was a retrospective analysis of 16 patients of CSTs, primarily treated with GKRS between 2009 and 2017. The patients underwent follow-up clinical and radiological evaluation at a regular interval. Data on clinical and imaging parameters were analyzed. The published literature on GKRS for CSTs was reviewed. There were total 16 patients (eight meningiomas, seven hemangiomas, and one schwannoma). Patients presented with a headache (56.3%), ptosis (50%), and/or restricted extraocular movements (50%). There was 46.6% tumor volume (TV) reduction after single-fraction GKRS. Hemangiomas showed best TV reduction (64% reduction at > 3-year follow-up) followed by schwannoma (41.5%) and meningioma (25.4%). 56.3% of patients developed transient hypoesthesia in trigeminal nerve distribution. 44.4% of patients became completely pain-free. Among cranial nerves, the superior division of the oculomotor nerve showed best outcome (ptosis 62.5%) followed by an improved range of EOM. There was no adverse event in the form of new-onset deficit, vascular complication, or malignant transformation except for one out of the field failures. Among available treatment options, GKRS is the most suitable option by virtue of its minimally invasive nature, optimal long-term tumor control, improvement in cranial neuropathies, cost-effectiveness, favorable risk-benefit ratio, and minimal long-term complications.
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Akers A, Al-Shahi Salman R, A. Awad I, Dahlem K, Flemming K, Hart B, Kim H, Jusue-Torres I, Kondziolka D, Lee C, Morrison L, Rigamonti D, Rebeiz T, Tournier-Lasserve E, Waggoner D, Whitehead K. Synopsis of Guidelines for the Clinical Management of Cerebral Cavernous Malformations: Consensus Recommendations Based on Systematic Literature Review by the Angioma Alliance Scientific Advisory Board Clinical Experts Panel. Neurosurgery 2017; 80:665-680. [PMID: 28387823 PMCID: PMC5808153 DOI: 10.1093/neuros/nyx091] [Citation(s) in RCA: 267] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 02/09/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite many publications about cerebral cavernous malformations (CCMs), controversy remains regarding diagnostic and management strategies. OBJECTIVE To develop guidelines for CCM management. METHODS The Angioma Alliance ( www.angioma.org ), the patient support group in the United States advocating on behalf of patients and research in CCM, convened a multidisciplinary writing group comprising expert CCM clinicians to help summarize the existing literature related to the clinical care of CCM, focusing on 5 topics: (1) epidemiology and natural history, (2) genetic testing and counseling, (3) diagnostic criteria and radiology standards, (4) neurosurgical considerations, and (5) neurological considerations. The group reviewed literature, rated evidence, developed recommendations, and established consensus, controversies, and knowledge gaps according to a prespecified protocol. RESULTS Of 1270 publications published between January 1, 1983 and September 31, 2014, we selected 98 based on methodological criteria, and identified 38 additional recent or relevant publications. Topic authors used these publications to summarize current knowledge and arrive at 23 consensus management recommendations, which we rated by class (size of effect) and level (estimate of certainty) according to the American Heart Association/American Stroke Association criteria. No recommendation was level A (because of the absence of randomized controlled trials), 11 (48%) were level B, and 12 (52%) were level C. Recommendations were class I in 8 (35%), class II in 10 (43%), and class III in 5 (22%). CONCLUSION Current evidence supports recommendations for the management of CCM, but their generally low levels and classes mandate further research to better inform clinical practice and update these recommendations. The complete recommendations document, including the criteria for selecting reference citations, a more detailed justification of the respective recommendations, and a summary of controversies and knowledge gaps, was similarly peer reviewed and is available on line www.angioma.org/CCMGuidelines .
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Affiliation(s)
| | | | - Issam A. Awad
- Neurovascular Surgery Program, Section of Neurosurgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois
| | | | - Kelly Flemming
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Blaine Hart
- Department of Radiology, University of New Mexico, Albuquerque, New Mexico
| | - Helen Kim
- Department of Anesthesia and Perioperative Care, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | | | - Douglas Kondziolka
- Departments of Neurosurgery and Radiation Oncology, NYU Langone Medical Center, New York City, New York
| | | | - Leslie Morrison
- Departments of Neurology and Pediatrics, University of New Mexico, Albuquerque, New Mexico
| | - Daniele Rigamonti
- Department of Neurosurgery, Johns Hopkins Medicine, Baltimore, Maryland
| | - Tania Rebeiz
- Neurovascular Surgery Program, Section of Neurosurgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois
| | | | - Darrel Waggoner
- Department of Human Genetics and Pediatrics, University of Chicago Medicine and Biological Sciences, Chicago, Illinois
| | - Kevin Whitehead
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
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Colletti G, Ierardi AM. Understanding venous malformations of the head and neck: a comprehensive insight. Med Oncol 2017; 34:42. [PMID: 28181207 DOI: 10.1007/s12032-017-0896-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 01/23/2017] [Indexed: 01/10/2023]
Abstract
Venous malformations (VMs) are congenital vascular malformations. They are very often misnamed and thus incorrectly managed. The aim of the present paper is to provide the reader with the most updated literature available and to offer a detailed description of each single aspect of this disease. In detail, the paper discusses the epidemiology, the embryological origins and the physiopathology of VMs. Then, the clinical features of sporadic, inherited and syndromic VMs are discussed. The instrumental diagnosis is presented, and the role of US, CT, MRI and phlebography is pointed out. Differential diagnoses with other vascular malformations and tumors are described. The clinical session ends with the staging of VMs relying on MRI and rheological features. All aspects of treatment are described: conservative measures, medical treatment, sclerotherapy, laser and surgery are thoroughly discussed. A section is reserved to bony VMs. Their clinical aspects and the appropriate treatment are presented.
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Abstract
The anatomy of the skull base is complex with multiple neurovascular structures in a small space. Understanding all of the intricate relationships begins with understanding the anatomy of the sphenoid bone. The cavernous sinus contains the carotid artery and some of its branches; cranial nerves III, IV, VI, and V1; and transmits venous blood from multiple sources. The anterior skull base extends to the frontal sinus and is important to understand for sinus surgery and sinonasal malignancies. The clivus protects the brainstem and posterior cranial fossa. A thorough appreciation of the anatomy of these various areas allows for endoscopic endonasal approaches to the skull base.
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Affiliation(s)
- Chirag R Patel
- Department of Otolaryngology, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite 500, Pittsburgh, PA 15213, USA; Center for Cranial Base Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite 500, Pittsburgh, PA 15213, USA
| | - Juan C Fernandez-Miranda
- Center for Cranial Base Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite 500, Pittsburgh, PA 15213, USA; Surgical Neuroanatomy Lab, Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, PUH B-400, Pittsburgh, PA 15213, USA
| | - Wei-Hsin Wang
- Surgical Neuroanatomy Lab, Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, PUH B-400, Pittsburgh, PA 15213, USA; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Eric W Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite 500, Pittsburgh, PA 15213, USA; Center for Cranial Base Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite 500, Pittsburgh, PA 15213, USA.
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31
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Katta M, Mehta H, Ho I, Garrick R, Chong R. Optical coherence tomography imaging of optic disc cavernous haemangioma. J Clin Neurosci 2016; 33:234-5. [PMID: 27469415 DOI: 10.1016/j.jocn.2016.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/16/2016] [Accepted: 04/20/2016] [Indexed: 11/23/2022]
Abstract
Optic disc cavernous haemangiomas are either found incidentally or after presentation with vitreous haemorrhage. They are characterised by a cluster of grapes appearance to the multiple vascular saccules that make up the tumour. They are more often found in the retinal periphery but rarely occur at the optic disc. Optical coherence tomography (OCT) imaging may be a useful non-invasive imaging modality to follow-up these lesions. We present the case of an asymptomatic 60-year-old lady referred from her optometrist with a lesion overlying the optic disc and the ensuing diagnosis of cavernous haemangioma using fundus fluorescein angiography and OCT.
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Brinda MAA, Manjunath S, Balasubrahmaniya KS, Manjunath RD, Nanjaiah B. Intramuscular Ossified Haemangioma: A Rare Case Report. J Clin Diagn Res 2015; 9:PD19-21. [PMID: 26500953 DOI: 10.7860/jcdr/2015/14366.6484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/25/2015] [Indexed: 11/24/2022]
Abstract
Haemangiomas are benign vascular neoplasm and intra muscular haemangioma constitutes 0.8% of all. Of these intramuscular ossified haemangioma is very rare. Here we are reporting a 30-year-old female admitted in our institute with complaints of pain and swelling in the medial aspect of right thigh for duration of one year. On evaluation CT showed well defined soft tissue lesion with calcification in vastus medialis which on guided aspiration showed numerous RBCs along with clusters of histiocytes with occasional calcified specs seen without presence of granulomas. The swelling was excised and histopathology confirmed intra muscular haemangioma with ossification. We hereby reporting a rare case of calcified intra muscular cavernous haemangioma which should be considered as differential diagnosis in any case of deep seated swelling with unexplained pain.
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Affiliation(s)
| | - Srinidhi Manjunath
- Senior Resident, Department of General Surgery, Mysore Medical College and Research Institute , Mysore, India
| | | | - R D Manjunath
- Assistant Professor, Department of General Surgery, Mysore Medical College and Research Institute , Mysore, India
| | - Basavaraju Nanjaiah
- Post Graduate, Department of General Surgery, Mysore Medical College and Research Institute , Mysore, India
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Jeong WJ, Choi I, Seong HY, Roh SW. Thoracic Extradural Cavernous Hemangioma Mimicking a Dumbbell-Shaped Tumor. J Korean Neurosurg Soc 2015; 58:72-5. [PMID: 26279817 PMCID: PMC4534743 DOI: 10.3340/jkns.2015.58.1.72] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 01/21/2015] [Accepted: 01/23/2015] [Indexed: 11/27/2022] Open
Abstract
Dumbbell-shaped spinal extradural cavernous hemangioma is rare. The differential diagnosis of dumbbell-shaped spinal tumors based on magnetic resonance imaging includes schwannoma and lymphoma. Here, we report a dumbbell-shaped spinal extradural cavernous hemangioma with intrathoracic growth on T2-3 in a 64-year-old man complaining of right side infrascapular area back pain with no neurologic deficit. The cavernous hemangioma was resected through combined video-assisted thoracoscopy and laminectomy without a fusion procedure. The patient had tolerable operative wound pain with no neurologic deficit after surgery. Based on magnetic resonance imaging findings and a review of the literature, we discuss cavernous hemangioma among the differential diagnosis of paravertebral dumbbell-shaped spinal tumors and the importance of complete resection.
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Affiliation(s)
- Won Joo Jeong
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Il Choi
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Han Yu Seong
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Woo Roh
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Matsuba T, Hisashi Y, Yotsumoto G, Imoto Y. A rare cardiac haemangioma in the right ventricle diagnosed accurately using ¹⁸F-fluorodeoxyglucose-positron emission tomography. Eur J Cardiothorac Surg 2015; 47:e223-5. [PMID: 25602049 DOI: 10.1093/ejcts/ezu540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 12/19/2014] [Indexed: 11/13/2022] Open
Abstract
A right ventricular cardiac tumour was incidentally detected in a 61-year-old man during a preoperative examination for coronary artery bypass grafting (CABG). Findings on computed tomography and magnetic resonance imaging suggested the differential diagnoses of myxoma, haemangioma and haemangiosarcoma, and it was difficult to identify whether the tumour was benign or malignant. (18)F-fluorodeoxyglucose-positron emission tomography strongly suggested a benign tumour. We enucleated the tumour, because an intraoperative frozen section also strongly suggested a benign origin. After resection, CABG under cardiopulmonary bypass was performed. Histopathological and immunohistochemical analysis indicated a cavernous haemangioma without evidence of malignant tissue. The patient has survived 20 months after surgery with no evidence of tumour recurrence.
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Affiliation(s)
- Tomoyuki Matsuba
- Department of Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yosuke Hisashi
- Department of Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Goichi Yotsumoto
- Department of Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yutaka Imoto
- Department of Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Jang D, Kim C, Lee SJ, Ryu YJ, Kim J. Pure spinal epidural cavernous hemangioma with intralesional hemorrhage: a rare cause of thoracic myelopathy. Korean J Spine 2014; 11:85-8. [PMID: 25110490 PMCID: PMC4124926 DOI: 10.14245/kjs.2014.11.2.85] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/05/2014] [Accepted: 06/20/2014] [Indexed: 11/21/2022]
Abstract
Although cavernous hemangiomas occur frequently in the intracranial structures, they are rare in the spine. Most of spinal hemangiomas are vertebral origin and "pure" epidural hemangiomas not originating from the vertebral bone are very rare. Our spinal hemangioma case is extremely rare because of its "pure" epidural involvement and intralesional hemorrhage. A 64-year-old man presented with progressive paraparesis from two months ago. His motor weakness was rated as grade 4/5 in bilateral lower extremities. He also complained of decreased sensation below the T4 sensory dermatome, which continuously progressed to the higher dermatome level. Magnetic resonance imaging demonstrated thoracic spinal tumor at T3-T4 level. The tumor was located epidural space compressing thoracic spinal cord ventrally. The tumor was not involved with the thoracic vertebral bone. We performed T3-5 laminectomy and removed the tumor completely. The tumor was not infiltrating into intradural space or vertebral bone. The histopathologic study confirmed the epidural tumor as cavernous hemangioma. Postoperatively, his weakness improved gradually. Four months later, his paraparesis recovered completely. Here, we present a case of pure spinal epidural cavernous hemangioma, which has intralesional hemorrhage. We believe cavernous hemangioma should be included in the differential diagnosis of the spinal epidural tumors.
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Affiliation(s)
- Donghwan Jang
- Department of Neurosurgery, Kangwon National University Hospital, Chuncheon, Gangwon, Korea
| | - Choonghyo Kim
- Department of Neurosurgery, Kangwon National University Hospital, Chuncheon, Gangwon, Korea
| | - Seung Jin Lee
- Department of Neurosurgery, Kangwon National University Hospital, Chuncheon, Gangwon, Korea
| | - Young-Joon Ryu
- Department of Pathology, Kangwon National University Hospital, Chuncheon, Gangwon, Korea
| | - Jiha Kim
- Department of Neurosurgery, Kangwon National University Hospital, Chuncheon, Gangwon, Korea
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Abstract
Eight year-old boy reported to ENT, OPD with a large swelling in the oral cavity arising from his left tonsil. The mass was excised by transoral approach and histopathological examination proved to be a case of lymphangioma tonsil. This case is reported for its rarity.
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Affiliation(s)
- Orina Raha
- Department of Otorhinolaryngology, Silchar Medical College & Hospital, 14 Silchar, Assam India
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